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Form Search Results

Select All
NameDescriptionTransaction TypeForm NumberStates
 Accelerated Benefit Claim Complete to file an accelerated benefit claim. Claims NZ1361 04/15 NY
Accelerated Benefit Claim Complete to file an accelerated benefit claim. Claims Z1361 04/15 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Additional Premium for Perspective, Perspective II, Perspective Advisory, Focus, L Series and Rewards Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits NV6243 04/17 NY
Additional Premium for Perspective Advisors II Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits NV6245 04/17 NY
Affidavit of LOST POLICY Use this form when a policy/contract is lost. Other Transactions N2028 04/15 NY
Affidavit of LOST POLICY Use this form when a policy/contract is lost. Other Transactions X2028 04/15 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Annuity Direct Deposit Request Use to set up or change bank information for direct deposit into client's bank account. Payments & Deposits, Withdrawal N1091 04/15 NY
Annuity Partial Withdrawal or Full Surrender Request Complete this form to request Partial or Full Withdrawal or to request Required Minimum Distribution. Withdrawal N3101 01/16 NY
Annuity Partial Withdrawal or Full Surrender Request Complete this form to request Partial or Full Withdrawal or to request Required Minimum Distributions from OptiMax NY and OptiMax NY Level Rate. Withdrawal N3101G 01/16 NY
Annuity Service Request For changes to owner, annuitant, beneficiary, name, address, premium mode, statement frequency or to authorize a caller or request duplicate contract. Account Changes X0365 09/16 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Email Blank Form

Before investing, investors should carefully consider the investment objectives, risks, charges and expenses of the variable insurance product, including its underlying investment options. The current prospectus (or for the variable insurance products the contract prospectus and underlying fund prospectuses, which are contained in the same document) provides this and other important information. Please contact your representative or the Company to obtain the prospectus(es). Please read the prospectus(es) carefully before investing or sending money.

Annuities are issued by Jackson National Life Insurance Company (Home Office: Lansing, Michigan) and in New York, annuities are issued by Jackson National Life Insurance Company of New York (Home Office: Purchase, New York). Variable products are distributed by Jackson National Life Distributors LLC. May not be available in all states and state variations may apply. These products have limitations and restrictions. Contact the Company for more information. Jackson is the marketing name for Jackson National Life Insurance Company and Jackson National Life Insurance Company of New York.

• Not FDIC/NCUA insured • Not bank/CU guaranteed • May lose value •
• Not a deposit • Not insured by any federal agency •

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CMC17302 07/16

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Jackson National Life Insurance Company
1 Corporate Way
Lansing, MI 48951